The Role of Autonomy and Pubertal Status in Understanding Age Differences in Maternal Involvement in Diabetes Responsibility across Adolescence

Palmer, Debra L.; Berg, Cynthia A.; Wiebe, Deborah J.; Beveridge, Ryan M.; Korbel, Carolyn; Upchurch, Renn; Swinyard, Michael; Lindsay, Rob; Donaldson, David

doi:10.1093/jpepsy/jsh005

Cited by 143 publications

(157 citation statements)

References 38 publications

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“…However, the authors did not report what percentage of these 400 patients, if any, were children or adolescents or what the discontinuation rates were in general for the youth. Reports on CSII discontinuation in adult populations may not be applicable to youth with type 1 diabetes given the unique physiologic and psychosocial characteristics of children and adolescents, such as pubertal growth and development, reliance on family members for assistance, and the challenges of increasing autonomy during adolescence (11)(12)(13).…”

Section: Resultsmentioning

confidence: 99%

Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes

et al. 2006

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OBJECTIVE -To examine longitudinal outcomes, rate of and reasons for discontinuation, and predictors of insulin pump success in a cohort of youth initiating pump therapy.RESEARCH DESIGN AND METHODS -We followed a cohort of youth with type 1 diabetes (n ϭ 161) starting the pump between 1998 and 2001 and recorded natural history of treatment.RESULTS -At pump start, patients (71% female) had a mean age of 14.1 Ϯ 3.7 years, diabetes duration of 7.1 Ϯ 4.0 years, daily blood glucose monitoring (BGM) frequency of 4.0 Ϯ 1.2, a daily insulin dose of 1.0 Ϯ 0.3 units/kg, and an HbA 1c (A1C) of 8.4 Ϯ 1.4%. After 1 year, mean daily BGM frequency was 4.5 Ϯ 1.7, daily insulin dose was 0.8 Ϯ 0.2 units/kg, and A1C was 8.1 Ϯ 1.3% (all baseline versus 1-year data, P Ͻ 0.01). As of 2005, 29 patients (18%) had resumed injection therapy at a mean age of 17.0 Ϯ 2.9 years after a mean duration of pump use of 2.1 Ϯ 1.3 years. BGM frequency at baseline and at 1 year was significantly lower in the patients who resumed injection therapy (P Ͻ 0.02). In addition, patients who remained on the pump had lower A1C than those who resumed injection therapy at both 1 year (P ϭ 0.04) and at the most recent clinic visit (P ϭ 0.01).CONCLUSIONS -After an average of 3.8 years, Ͼ80% of pediatric patients maintained pump therapy with preservation of baseline A1C. Patients discontinuing the pump were less adherent and did not achieve equivalent glycemic benefit compared with continued users; these patients require ongoing support aimed at improving adherence and outcomes. Diabetes Care 29:2355-2360, 2006C ontinuous subcutaneous insulin infusion (CSII) is a safe and effective mode of insulin delivery in pediatric patients with type 1 diabetes. Several pump studies have demonstrated improved (1-5) or equivalent (6 -9) glycem i c c o n t r o l w i t h o u t i n c r e a s e d hypoglycemia (1)(2)(3)(4)(5)7,9) and with improved quality of life (2,7). Although there are several advantages of pump therapy in the pediatric population, barriers to success remain. Furthermore, pump discontinuation rates and reasons for discontinuation have not been well described in the pediatric literature.Health care providers strive to optimize glycemic control in patients with diabetes, and, given the benefits of pump therapy, they may consider CSII for most patients. In turn, treatment efforts should maximize success and intervene early for those individuals identified at risk for pump failure. Thus, we examined the demographic and diabetes-specific characteristics of a large group of pediatric patients with type 1 diabetes initiating pump therapy in order to determine the rate of and reasons for pump discontinuation. Next, we assessed the glycemic outcomes of those who maintained CSII therapy and those who resumed injection therapy. Finally, we compared patients who discontinued pump therapy with those who maintained pump therapy to further characterize the predictors of pump failure and identify opportunities for intervention. RESEARCH DESIGN ANDMETHODS -Participants were pati...

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Section: Resultsmentioning

confidence: 99%

Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes

et al. 2006

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“…Mothers' and fathers' acceptance and monitoring were also not moderated by age, indicating that the benefits of acceptance and monitoring exist across the preto mid-adolescence age range (10 -14 years), a time when parents are decreasing their level of involvement in diabetes management (8,10). The importance of fathers' acceptance and monitoring may differ when examined across a broader age range, given Wysocki and Gavin's observations regarding the increasing importance of fathers during mid-to late adolescence (12).…”

Section: Methodsmentioning

confidence: 99%

“…The increasing independence of adolescents from their parents in carrying out diabetes tasks (8,10) may make monitoring by both mothers and fathers especially important (11). Ellis et al (9) found that diabetes-specific monitoring during adolescence was associated with better metabolic control via its association with better regimen adherence.…”

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confidence: 99%

Role of Parental Monitoring in Understanding the Benefits of Parental Acceptance on Adolescent Adherence and Metabolic Control of Type 1 Diabetes

et al. 2008

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OBJECTIVE—This study examined 1) whether the benefits of mothers’ and fathers’ accepting relationships with their adolescents regarding diabetes control were due to parental monitoring and 2) how parents together may provide sufficient acceptance and monitoring for diabetes management. RESEARCH DESIGN AND METHODS—Adolescents aged 10–14 years with type 1 diabetes (n = 185) and their mothers (n = 185) and fathers (n = 145) completed assessments of parental acceptance and monitoring of diabetes tasks. Adolescents completed a modified version of the Self-Care Inventory (1) to measure adherence. A1C scores were used as a marker of glycemic control. RESULTS—Mediational analyses revealed that the benefits of adolescents’ reports of fathers’ acceptance on A1C and mothers’ and fathers’ acceptance on better adherence were partially mediated by monitoring. Both mothers’ and fathers’ monitoring and fathers’ acceptance had independent effects in predicting adherence. However, only fathers’ monitoring had an independent effect on A1C. The effect of fathers’ monitoring on A1C occurred as fathers were monitoring at a lower level than mothers. Mothers’ and fathers’ reports of their own acceptance and monitoring were not associated with A1C or adherence. CONCLUSIONS—Results reveal the importance of fathers’ acceptance and monitoring in diabetes management, a role that should be encouraged, despite the little attention it has received.

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“…As such, the potential for short-term improvement is minimized, particularly among the younger participants. It is also possible that the design of the intervention was more appropriate for middle adolescents; a youth-focused intervention may not show effects until the children achieve more autonomy in their diabetes management (36). A more active engagement of parents and facilitation of parentchild cooperation may be needed to achieve an effect during early adolescence.…”

Section: Conclusion -Findings Indi-mentioning

confidence: 99%

Diabetes Personal Trainer Outcomes

et al. 2007

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OBJECTIVE -To assess the social-cognitive, behavioral, and physiological outcomes of a self-management intervention for youth with type 1 diabetes.RESEARCH DESIGN AND METHODS -A total of 81 youth with type 1 diabetes aged 11-16 years were randomized to usual care versus a "diabetes personal trainer" intervention, consisting of six self-monitoring, goal-setting, and problem-solving sessions with trained nonprofessionals. Assessments were completed at baseline and multiple follow-up intervals. A1C data were obtained from medical records. ANCOVA adjusting for age and baseline values were conducted for each outcome.RESULTS -At both short-term and 1-year follow-up, there was a trend for an overall intervention effect on A1C (short-term F ϭ 3.71, P ϭ 0.06; 1-year F ϭ 3.79, P ϭ 0.06) and a significant intervention-by-age interaction, indicating a great effect among older than younger youth (short-term F ϭ 4.78, P ϭ 0.03; 1-year F ϭ 4.53, P ϭ 0.04). Subgroup analyses demonstrated no treatment group difference among younger youth but a significant difference among the older youth. No treatment group differences in parent or youth report of adherence were observed. CONCLUSIONS It is well-established that a deterioration in glycemic control accompanies adolescence (1), in part due to hormonal changes associated with puberty (2) but also resulting from worsening adherence (3,4). Consequences include hospitalizations and even mortality from diabetic ketoacidosis (5) and physical damage leading to later complications (6). Because diabetes management during childhood is associated with adult behavior and health outcomes (7,8), intervention to enhance diabetes self-management skills may be critical in decreasing the rate of physical health problems throughout the lifespan.Optimal diabetes management is a formidable undertaking for youth, who are still maturing cognitively and socially. Typically, self-management skills are not well developed, and evaluation of behavioral options and consequences may be inadequate. Despite concerns regarding readiness for diabetes management responsibility, increased independence from parents often results in youth assuming additional responsibility at the cost of poorer adherence.The development of effective intervention models during this transitional period is critical and may be facilitated by predominant theoretical perspectives. Social cognitive theory (9) emphasizes the reciprocal relationship of beliefs and social/environmental factors. One's outcome expectations (expected positive and negative outcomes of behaviors) and selfefficacy (perceived ability to perform behaviors) develop from experience, are influenced by cognitive and behavioral skills, and affect subsequent behavior (10,11). These beliefs provide the underpinnings for motivation and selfmanagement processes, as emphasized by the self-regulation model (12), which explains health-related behavior as a function of appraisal of the situation, perceived choice of actions, and evaluation of the outcomes of those actions (13,14). ...

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The Role of Autonomy and Pubertal Status in Understanding Age Differences in Maternal Involvement in Diabetes Responsibility across Adolescence

Abstract: The importance of chronological age for changes in maternal involvement suggests the need to examine mothers' and adolescents' developmental expectations for diabetes management. The reasons for transferring responsibility from mother to child suggest many avenues for intervention.

Cited by 143 publications

References 38 publications

Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes

Durability of Insulin Pump Use in Pediatric Patients With Type 1 Diabetes

Role of Parental Monitoring in Understanding the Benefits of Parental Acceptance on Adolescent Adherence and Metabolic Control of Type 1 Diabetes

Diabetes Personal Trainer Outcomes

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